Organization
MODERN KIDS DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN MICHAEL RAYBOULD D.M.D. (PRESIDENT/CEO)
(859) 321-7051
Entity
Organization
Contact information
Practice address
4384 CLEARWATER WAY, SUITE 150, LEXINGTON, KY 40515-6477
(859) 321-7051
Mailing address
725 BEECHMONT RD, SUITE 150, LEXINGTON, KY 40502-2837
(859) 321-7051
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
8732
KY
Other
Enumeration date
01/13/2015
Last updated
04/13/2015
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